Optometric Management Of Diabetic Retinopathy

Question 1

What influences the way in which optoms manage diabetic patients?

Answer 1

Whether they attend regular screening

Question 2

When do you dilate a patient?

Answer 2

• px has no knowledge of screening and isn’t enrolled
• px is unsure about the interval from the last screening to the next screening
• px was unsure about the outcome of the previous screening
• diabetic px with sx of blur which doesn’t improve with pinhole
• blur that isn’t refractive with no sx
• asymptomatic blurred vision

Question 3

When would you not dilate?

Answer 3

In cases of an asymptomatic px who has regular screening

Question 4

When do we not need to refer diabetics who are at risk of retinopathy?

Answer 4

With patients who present already under the care of an ophthalmologist and go to have regular screening

Question 5

If a px is already under screening, could you still refer them?

Answer 5

Yes, the reason being that if you feel the severity of the retinopathy will increase between the this app and the next screening then you can refer them

Question 6

What is referable for retinopathy?

Answer 6

Mild pre prolif changes (anything beyond no retinopathy)

Question 7

What is the procedure after the px has been referred for diabetic retinopathy

Answer 7

The screener passes their findings on to an ROG who may be a grader or opthal. And if the rog decides that the retinopathy can’t be managed by annual screening, then they are passed onto a surveillance screening which is more frequent supervision. However if they are too severe then urgent, same day referral may be necessary. If they aren’t as severe as first thought then they can be degraded back down to annual screening

Question 8

What is the classification of retinopathy?

Answer 8

R0- none
R1-background
R2-pre-proliferative
R3-proliferative

Question 9

What is the referral criteria for no detectable retinopathy?

Answer 9

We no longer need to write a letter to the gp about the px’s results and patients should be placed on a one year annual screening. We should always confirm whether a px is being screened and if not write to the gp asking for them to be enrolled

Question 10

What are the typical findings for background retinopathy?

Answer 10

Microaneurysms and haemorrhages

Question 11

What is the referral for background diabetic retinopathy?

Answer 11

Confirm the px is attending screening and depending on the severity e.g. If there’s more haemorrhages than normal or more microaneurysms, then you can choose to refer the px routinely

Question 12

What does the term pre-proliferative describe?

Answer 12

Retinopathy with significant ischemia

Question 13

What are the signs found in pre proliferative retinopathy?

Answer 13

Microaneurysms, haemorrhages, cotton wool spots, exudates, beading, looping,Irma

Question 14

What are patients that have Irma at risk of?

Answer 14

They are at risk of being misdiagnosed. It’s hard to distinguish between Irma and neovasc so it’s better to just refer in patients with Irma in case of misdiagnosis

Question 15

What are patients with pre-prolif at risk of?

Answer 15

Neovasc

Question 16

If a patient with pre-prolif enters and the optom suspects that the px isn’t in screening or missed their last app or if the optom suspects the signs have progressed, what should the optom do?

Answer 16

They should initiate their own referral highlighting that there is significant ischemia

Question 17

How long after are pre-proliferative patients seen?

Answer 17

6 weeks

Question 18

What is the referral for diabetic maculopathy?

Answer 18

Urgent referral

Question 19

What is the treatment for diabetic maculopathy?

Answer 19

Anti-VEGF injections

Question 20

How long after will diabetic maculopathy patients be seen?

Answer 20

1 month

Question 21

What is the definition of maculopathy?

Answer 21

Any microaneurysms or haemorrhage within 1 disc diameter of the centre of the fovea with best va of less than 6/12 and where the cause is reduced vision is known and isn’t diabetic maculopathy

Question 22

When does maculopathy not require referral?

Answer 22

When you find microaneurysms but the vision is still good

Question 23

When should you refer maculopathy?

Answer 23

When the vision seems to be declining or the px is complaining of blurred vision we should refer unless we know they already are being referred

Question 24

Patients that have proliferative retinopathy, what are they at risk of?

Answer 24

Visual impairment

Question 25

What would happen if the px isn’t part of screening and is showing signs of proliferative retinopathy?

Answer 25

Optoms need to phone the hospital and explain the findings which require an urgent referral and record details of the phone call

Question 26

How long after will patients that have been referred due to proliferative be seen?

Answer 26

2 weeks

Question 27

What is regarded as severe complications of proliferative retinopathy?

Answer 27

Px with pre retinal or vitreous haemorrhages or neovasc glaucoma due to rubeosis

Question 28

What is the referral for severe complications for proliferative retinopathy?

Answer 28

Emergency (same day) and telephone the ophthalmologist

Question 29

When referring a px, what’s the most important feature of a referral letter?

Answer 29

Consise and accurate description of sx and signs and using the appropriate classification. Optom should clearly identify signs and sx